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Drug Interactions between apalutamide and elagolix / estradiol / norethindrone

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

norethindrone apalutamide

Applies to: elagolix / estradiol / norethindrone and apalutamide

Consumer information for this interaction is not currently available.

ADDITIONAL CONTRACEPTION RECOMMENDED: Coadministration with potent inducers of CYP450 3A4 may reduce the efficacy of contraceptive hormones as estrogens and progestins have been shown to be partially metabolized by CYP450 3A4. In a pharmacokinetic study of 28 healthy women, the systemic exposures (AUCs) of ethinyl estradiol and norethindrone decreased by 64% and 60%, respectively when coadministered with the potent CYP450 3A4 inducer rifampin.

MANAGEMENT: For patients receiving hormonal contraceptives, additional or alternative non-hormonal contraceptive methods may be advisable during concomitant therapy with potent CYP450 3A4 inducers and patients should be advised of the risk of breakthrough bleeding and unintended pregnancy. Additional or alternative non-hormonal contraceptive methods may be recommended beyond discontinuation of the CYP450 3A4 inducer(s). Individual product labeling should be consulted for specific time frames. Although breakthrough bleeding is not necessarily indicative of low ethinyl estradiol serum levels or increased risk of ovulation, some clinicians suggest that women who experience breakthrough bleeding during enzyme-inducing therapy may be prescribed an increased dose of ethinyl estradiol above 50 mcg daily by combining more than one formulation of contraceptive pill if necessary. For emergency contraception in patients who have used an hepatic enzyme inducer in the past 4 weeks, a non-hormonal emergency contraceptive (e.g., copper intrauterine device) is considered preferable. If this is not possible, some authorities recommend that the usual dose of levonorgestrel (1.5 mg) should be doubled to 3 mg and taken as a single dose as soon as possible (within 72 hours of unprotected sexual intercourse). However, there are no data on efficacy, compliance, or side effects of this regimen. Intrauterine systems are unlikely to be significantly affected because of their local action. Input from a gynecologist or similar expert on adequate contraception, including emergency contraception, should be sought as needed.

Moderate

estradiol apalutamide

Applies to: elagolix / estradiol / norethindrone and apalutamide

Apalutamide may reduce the blood levels and effects of estradiol. If you are using low-dose oral contraceptives, you may have an increased risk of breakthrough bleeding and unintended pregnancy. You should discuss the use of alternative or additional methods of birth control with your healthcare provider. If you take hormone replacement for menopause, notify your doctor if your medication is no longer controlling your symptoms or you experience abnormal bleeding. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

estradiol elagolix

Applies to: elagolix / estradiol / norethindrone and elagolix / estradiol / norethindrone

Estradiol and other estrogen-containing medications may reduce the effectiveness of elagolix in treating your condition. If you require contraception, it is recommended that you use a non-hormonal form of contraception during treatment with elagolix and for one week after its discontinuation. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

norethindrone elagolix

Applies to: elagolix / estradiol / norethindrone and elagolix / estradiol / norethindrone

Elagolix may reduce the blood levels and effects of norethindrone. If you are using low-dose oral contraceptives, you may have an increased risk of breakthrough bleeding and unintended pregnancy. You should discuss the use of alternative or additional methods of birth control with your healthcare provider. If you take hormone replacement for menopause, notify your doctor if your medication is no longer controlling your symptoms or you experience abnormal bleeding. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

apalutamide elagolix

Applies to: apalutamide and elagolix / estradiol / norethindrone

Apalutamide may reduce the blood levels of elagolix in some patients, which may make the medication less effective. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Drug and food interactions

Moderate

norethindrone food

Applies to: elagolix / estradiol / norethindrone

Grapefruit juice may increase the blood levels of certain medications such as norethindrone. You may want to limit your consumption of grapefruit and grapefruit juice during treatment with norethindrone. However, if you have been regularly consuming grapefruit or grapefruit juice with the medication, then it is advisable for you to talk with your doctor before changing the amounts of these products in your diet, as this may alter the effects of your medication. Contact your doctor if your condition changes or you experience increased side effects. Orange juice is not expected to interact.

Minor

estradiol food

Applies to: elagolix / estradiol / norethindrone

Information for this minor interaction is available on the professional version.

Minor

norethindrone food

Applies to: elagolix / estradiol / norethindrone

Information for this minor interaction is available on the professional version.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.